Services In Northern Ireland Research Articles

Enquiring about traumatic experiences in bipolar disorder: A case note and self- report comparison

This study examined: (i) the prevalence of lifetime trauma, childhood trauma and trauma related to civil unrest in a Bipolar Disorder sample, and (ii) the agreement between rates of disclosure of trauma in case notes and self-report questionnaires. The case notes of sixty participants, recruited from a geographically well-defined mental health service in Northern Ireland, were examined for reports of experiences of lifetime, childhood and traumatic events related to civil conflict. The participants also completed self-report measures of trauma. Considerable differences were found between the prevalence of trauma as measured by self-report questionnaires and case notes reports. The prevalence of lifetime trauma as measured by the Trauma History Questionnaire was 61.7% (compared to case notes prevalence of 33.3%). The prevalence of moderate and severe levels of childhood trauma as measured by the Childhood Trauma Questionnaire was 65% (case notes 21.7%). Rates of trauma related to civil unrest were 35% (case notes 3.3%). Poor levels of agreement were found between all self-report trauma measures and case notes reports. Agreement on two categories of trauma (childhood emotional neglect and childhood physical neglect) reached statistical significance but kappa scores suggest this agreement was poor (κ=.14, p<.05; κ=.127, p<.05). It is probable that the increased rate of trauma disclosed in the self-report questionnaire arises because clinicians during initial assessment and subsequent treatment do not consistently enquire about trauma. The need for staff training is discussed.

Promoting mental health in Northern Ireland: addressing division, inequality and stigma

This article provides an overview of the literature on the impact of ‘the Troubles’ on mental health in Northern Ireland. It identifies three main phases of professional and policy response from concerns about the effects of the violence in the early 1970s, through many years of collective denial and neglect, until acknowledgment, following the Good Friday Agreement in 1998 (Northern Ireland Office, 1998), of high levels of trauma and unmet need. The issues of inequality and stigma are also considered and it is argued that peace is necessary but insufficient for promoting mental health. The development of mental health services in Northern Ireland and the relatively recent focus on promoting mental health are also outlined and examined. It is suggested that attempts to address the needs arising as a result of ‘the Troubles’ and more general mental health promotion strategies have, to some extent, developed in parallel and that it may be important to integrate these efforts. The relative under‐development of mental health services, the comprehensive Bamford Review (2005; 2006) and the positive approach of the Public Health Agency mean that, even in the current economic climate, there are great opportunities for progress. Routine screening, in primary care and mental health services for trauma, including Troubles‐related trauma, is recommended to identify and address these issues on an individual level. It is also argued, however, that more substantial political change is needed to effectively address societal division, inequality and stigma to the benefit of all.

Assessing the security needs of patients in medium secure psychiatric care in Northern Ireland

Aims and methodTo determine the security needs of patients in medium secure services in Northern Ireland and to identify those requiring long-term secure care. Patients were rated on the Security Needs Assessment Profile.ResultsFifteen patients (45%) could be managed in conditions of low security. Twelve patients (36%) require over 5 years' further treatment in secure care. Particular security needs include relational nursing skills, restricted access to alcohol and drugs, and robust physical security.Clinical implicationsThis study should be replicated across the UK to determine whether forensic services are responding to patients' needs. Pathways out of medium security need to be better developed, with regional expansion of low secure services.

Autobiographical memory specificity, depression, and trauma in bipolar disorder

In a bipolar disorder (BD) sample, the present study investigated: (i) the prevalence of trauma; (ii) the specificity of autobiographical memory (AM); (iii) the influence of childhood trauma on AM specificity, current inter-episode depressive mood, and BD severity; (iv) if AM specificity moderates the influence of childhood trauma on current inter-episode depressive mood and BD severity. Fifty-two participants were recruited from a geographically well-defined mental health service in Northern Ireland. The AM test, self-report measures of lifetime experience of trauma, childhood trauma, and depression were administered. Severity of BD was estimated utilizing a systematic tool for reviewing all available clinical data of participants. A high prevalence of trauma was found. A total of 94.2% (49/52) of participants reported experiencing a traumatic event in either childhood or adulthood. AM specificity was significantly lower than previous reports of such in major depression. However, whilst childhood trauma predicted current inter-episode depressive mood, childhood trauma was not predictive of BD severity or AM specificity. Moreover, the association between childhood trauma and depressed mood was not moderated by AM specificity. The findings of this study suggest a relationship between early psychosocial adversity and current inter-episode depressive mood in BD. In addition, levels of overgeneral AM are similar to that reported for depression, but are unrelated to childhood trauma, current inter-episode depressive mood, or BD severity. Clinical implications include the importance of routine assessment of trauma in BD and the need for adjunctive evidenced-based psychological therapies.

Marital Separation: Understanding and Meeting the Needs of Children

In her welcome and opening remarks, Lynne Peyton—a consultant specialising in children's services in Northern Ireland—set the scene for the proceedings. She confirmed that the escalating extent of ...

Palliative care: recognition of changing need in a children's spina bifida service in Northern Ireland

Background The regional Spina Bifida (SB) service for Northern Ireland is organised through two multi-professional teams based in Belfast, one for children and the other for those of older teenage years and beyond who transfer to an adult service. Although the incidence of SB is lower in comparison to earlier decades, more children are living longer with complex problems requiring support and remediation. This study examines the palliative care needs of children and young people with SB attending the children's service that were recognised as having a life-limiting dimension; required symptom control; and there was an expectation of early death.

An Audit of Assessment and Reporting by Approved Social Workers (ASWs)

This paper examines the routine practice of Approved Social Workers (ASWs) in adult mental health services in Northern Ireland. It begins with a review of existing literature on the ASW role before describing how a retrospective audit, using a mixed methods approach, was used to collect data on eighty-four assessments carried out to determine whether compulsory admission to hospital was needed. Respondents were also asked to consider how such assessments might be affected by proposed changes to the law in this field. The key findings highlighted a number of areas of practice that may be improved. There were inconsistencies in how the assessments were recorded and an uneven distribution of workloads across ASWs. Some problems were identified with inter-agency working and, in a quarter of the assessments, the ASW reported having felt afraid or at risk. The authors make a number of recommendations, which include: the use of a standard reporting procedure; that organisations should consider how to deliver a more even distribution of ASW workload; that protocols should be developed that ensure that ASWs are not left alone in potentially risky situations; and that joint assessments with General Practitioners should be required, rather than just recommended.

A Longitudinal Study of the Effects of Childhood Trauma on Symptoms and Functioning of People with Severe Mental Health Problems

This study examines the relationship between childhood trauma and the psychiatric symptoms and psychosocial functioning of adults with severe mental health problems. Participants (n = 31) were recruited from the caseloads of community mental health services in Northern Ireland and assessed at baseline, 9 months, and 18 months. More than half had a history of childhood trauma (n = 17). There were no differences between the no childhood trauma (n = 14) and childhood trauma groups on psychiatric symptoms, but a significant relationship was found between trauma history and all aspects of social functioning. Those with no history of trauma showed improved psychosocial functioning over time, whereas those with a history of trauma deteriorated. These findings have implications for current service provision.

Predictors of PTSD Symptoms in Response to Psychosis and Psychiatric Admission

The experiences of psychosis and psychiatric admission have the potential to act as events precipitating posttraumatic stress disorder (PTSD) symptoms. Known risk factors for the development of PTSD symptoms in adults were identified. These included childhood trauma, current psychiatric symptoms, perceived coercion, and relationships with mental health service providers. These factors were analyzed to determine if they were important in the development of PTSD symptoms in response to psychosis and admission. We used a cross-sectional design with a sample of 47 participants recruited from a service in Northern Ireland who had experienced psychosis and been discharged from inpatient treatment within 12 months of data collection. The main outcome measure was the impact of events scale-revised. Data was subject to correlation analyses. A cut-off point of r = +/- 0.25 was used to select variables for inclusion in hierarchical regression analyses. Forty-five percent and 31% of the sample had moderate to severe PTSD symptoms related to psychosis and admission, respectively. The majority of participants identified positive symptoms and the first admission as the most distressing aspects of psychosis and admission. Childhood sexual and physical traumas were significant predictors of some PTSD symptoms. Strong association was found between current affective symptoms and PTSD symptoms. A reduced sense of availability of mental health service providers was also associated with PTSD symptoms and depression. Awareness of risk factors for the development of PTSD symptoms in response to admission and psychosis raises important issues for services and has implications for interventions provided.

User Perspective on Palliative Care Services: Experiences of Middle-aged Partners Bereaved through Cancer Known to Social Work Services in Northern Ireland

This qualitative research study explores experiences of partners bereaved through cancer, who were resident in an urban area of Northern Ireland and who had been service users of the social work services. Data were collected in 2004 from 10 individuals who participated in semi-structured interviews. Emergent themes were identified using thematic content analysis and findings analysed under four categories: cancer journey; impact of bereavement; process of adjustment and change; and experience of support services. Opportunities to facilitate communication were not always maximised, often resulting in poor bereavement outcomes. Although hospices undertook bereavement risk assessment, participants were unaware of its use and queried its accuracy without service user involvement. The most cited informal support was family and friends, although such help was time-limited. Service user feedback regarding social workers was generally positive; however, there was a lack of knowledge about their role in palliative care. Post-bereavement adjustment was influenced by the quality of social networks, the responsibilities of lone parenthood, and challenges to life values and core beliefs. A framework for palliative care social work has been recommended based on research findings.

Social Care Governance within a Community Team Setting

The Health and Personal Social Services, Improvement and Regulation (NI) Order 2003, provides a legal framework that places a statutory requirement on health and personal social services in Northern Ireland to provide good quality services. Social care governance underpins the execution of this requirement, and relates to the delivery of safe and appropriate services for people with learning disabilities. The Directors of Social Services asked DHSSPSNI to fund a project worker through the Clinical and Social Care Governance Support Team to take this work forward. They asked for learning materials to be developed. A partnership was formed with the Social Care Institute for Excellence, and they provided the knowledge base for the workbook. The process of developing the workbook involved working with five pilot sites throughout Northern Ireland. The community learning disability team based in the Newry and Mourne Locality of the Southern Health and Social Care Trust participated in the pilot. This paper details the experiences of the team, the work done to date and the ongoing process of maintaining a focus on governance issues.

'The Scarlet Woman in Person': The Establishment of a Family Planning Service in Northern Ireland, 1950-1974

There is now an increasing body of research on the history of birth control and family planning. However, little work has yet been carried out on the provision and establishment of clinics at a local and regional level after 1945. This article seeks to fill this gap by describing and interpreting the establishment of a family planning service in Northern Ireland from the 1950s onwards. The distinctive religious, social, political and cultural situation in the province ensured that the manner in which clinics were established and the issues and difficulties that were faced differed from those elsewhere in the United Kingdom. Northern Ireland provides a valuable case-study of how local and regional differences influenced the establishment and growth of family planning services.

Effects of trauma on bipolar disorder: the mediational role of interpersonal difficulties and alcohol dependence

This study examined: (i) the prevalence of trauma in a bipolar disorder (BD) sample, and (ii) how trauma histories mediated by interpersonal difficulties and alcohol dependence impact on the severity of BD. The prevalence of posttraumatic stress disorder (PTSD) and its relationship to outcomes in BD were also examined. Sixty participants were recruited from a geographically well-defined mental health service in Northern Ireland. Self-reported trauma histories, PTSD, interpersonal difficulties and alcohol dependence and were examined in relation to illness severity. A high prevalence of trauma was found. Trauma predicted the frequency of hospital admissions (R(2) = 0.08), quality of life (R(2) = 0.23) and inter-episode depressive symptoms (R(2) = 0.13). Interpersonal difficulties, but not alcohol dependence, appeared to play an important role in mediating these adverse effects. While only 8% of the sample met criteria for active PTSD, this comorbid disorder was associated with BD severity. This study indicates that awareness of trauma is important in understanding individual differences in bipolar presentations. The theoretical and clinical implications of evidence that trauma is related to more adverse outcomes in BD are discussed. The finding that interpersonal difficulties mediate the relationship between trauma and BD severity is novel. The need for adjunctive evidence-based treatments targeting interpersonal difficulties is considered.

Engagement, workers' strategies, therapeutic relationships, coercion and outcomes in community mental health services in Northern Ireland

Engagement, workers' strategies, therapeutic relationships, coercion and outcomes in community mental health services in Northern Ireland

REMEMBERING ERIC AND SYLVIA LINDSAY DURING THE WAR YEARS

Don Nicholson recalls his WWII service in Northern Ireland and time spent in Armagh with the Lindsays discussing astronomy and enjoying their hospitality.

Care management in mental health services in England and Northern Ireland: do integrated organizations promote integrated practice?

To explore whether integrated structures are associated with more integrated and differentiated forms of care management in mental health services. Cross-sectional postal survey of care management arrangements in local authority social services departments in England (n=101) and health and social services Trusts in Northern Ireland (NI) (n=11). Some, but not all, indicators showed more evidence of integrated practice in NI mental health and social services. This included: greater involvement of health care staff in care management; greater multidisciplinary working and a more integrated approach to assessment and care planning processes; a more differentiated approach to care management, including greater targeting of care management resources; a closer link between care management and specialist provision; and overall more integrated practice. This study concurs with previous research showing that structurally integrated health and social services in NI are more conducive towards, although insufficient to secure, integrated working. As the nature, type of services and ways of working appear to be broadly similar in England and NI, this may imply that greater structural integration per se may not lead to better service outcomes.

Mental Health Law Reform: The Impact on Children and Young People in Northern Ireland

The Bamford Review of Mental Health and Learning Disability (Northern Ireland) was established in October 2002 to examine all aspects of the law, policy and provisions that affect people with mental health needs or a learning disability in Northern Ireland. Its report A Comprehensive Legislative Framework, which deals with the reform of law in this area, proposes significant change to mental health law, which is largely welcome. This article outlines some of those key changes and preliminary thoughts regarding the impact of some of the specific proposals on children and young people with mental health problems in Northern Ireland, highlighting those areas that warrant particular attention. Particular comment is made on current legislation and concerns regarding the funding and provision of child and adolescent services in Northern Ireland. Proposals in the Framework for the introduction of capacity legislation and the impact of such on children and young people with mental health problems are examined in light of recent legislative changes in Great Britain. Comment is also made on the need for significant changes in the law and policy regarding the provision of services and support to those children and young people with a personality disorder.

An evidence base for a palliative care chaplaincy service in Northern Ireland

Palliative care encompasses spiritual as well as physical, social and psychological aspects. Spiritual care has been identified as a key concern of dying patients. During an audit of the Northern Ireland Hospice chaplaincy service against the national Standards for Hospice and Palliative Care Chaplaincy (2003), 62 patients' spiritual needs along with their interactions with the hospice chaplains were assessed by using a questionnaire survey and reviewing data recorded on their pastoral care notes. Findings suggest that the Standards were useful for assessing and addressing spiritual needs. Access to the chaplaincy service (Standard 1) was partially met and Standard 2's spiritual criteria were fully met. The participants, of whom 92% had a faith in God or a Higher Being, highlighted their top six spiritual needs as: to have the time to think; to have hope; to deal with unresolved issues; to prepare for death; to express true feelings without being judged; to speak of important relationships. The majority of the participants (82%) felt their spiritual needs had been addressed and viewed their interaction with the chaplaincy service positively. Recommendations were made relating to improve communication of chaplaincy services. Palliative Medicine 2007; 21: 519—525

The Male Workforce in Intellectual Disability Services

Abstract Staff shortages are predicted in community social care sector services for people with intellectual disabilities (ID). One option is to attract more men to the workforce, which would also counter the present sex‐ratio (gender) imbalance among workers. Potential strategies for recruitment could be identified by analyzing the characteristics and experiences of the male staff currently employed in such jobs. To do this, the authors undertook three studies: (1) a census of 653 staff in statutory services within one Health and Social Services Board district in Northern Ireland; (2) a survey of 463 staff from both statutory and nonstatutory services; and (3) small sample focus groups with designated male staff. Findings were that fewer than 1 in 5 of the workforce in ID sector services in Northern Ireland were men, with significant variance (0–40%) depending upon the type of services. Men were more likely than women to be in full‐time posts; to be the main wage‐earner in the household, and to have entered ID sector jobs from noncare settings. Male staff reported that their motivation for undertaking work in this sector was often questioned by peers and that they felt exposed to accusations of abuse. Authors conclude that male staff recruitment could be boosted by increased pay and more opportunities for full‐time work and career progression. Career advisers, teachers, and parents need to promote the value and opportunities of work available in ID sector services. The unique contributions of male staff also need to be identified and recognized as a means of retaining existing staff and recruiting others.

The Times they are a Changing: The Challenges Facing Social Work in Northern Ireland

As public services in Northern Ireland begin to implement the far-reaching changes required by the Review of Public Administration, the likely consequences for social work services, including children's services, are considered. As no change occurs in a vacuum, this paper sets the Review of Public Administration in the context of other significant issues and developments influencing practice. It evaluates the social work profession's state of readiness for the challenges ahead and concludes that, while the key elements are in place, considerable leadership will be needed to ensure a coherent response to the new systems and requirements, oversee implementation of statutory responsibilities and to motivate, guide and retain a suitably qualified, experienced and confident workforce.